Provider Demographics
NPI:1104514678
Name:SQUIRES, SASHA MARIE J (MA, LCPC)
Entity type:Individual
Prefix:
First Name:SASHA MARIE
Middle Name:J
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RIVER RANCH LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-8628
Mailing Address - Country:US
Mailing Address - Phone:406-600-3756
Mailing Address - Fax:
Practice Address - Street 1:110 RIVER RANCH LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-8628
Practice Address - Country:US
Practice Address - Phone:406-600-3756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-62690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health